Measuring Intrahepatic Vascular Changes Using Contrast-Enhanced Ultrasonography to Predict the Prognosis of Alcoholic Hepatitis Combined with Cirrhosis: A Prospective Pilot Study.
- Author:
Min Sun PARK
1
;
Soonchang HONG
;
Yoo Li LIM
;
Seong Hee KANG
;
Soon Koo BAIK
;
Moon Young KIM
Author Information
- Publication Type:Original Article
- Keywords: Hepatitis, alcoholic; Liver cirrhosis, alcoholic; Hepatic veins; Ultrasonography, contrast-enhanced
- MeSH: Alcoholics*; Fibrosis*; Hepatic Veins; Hepatitis, Alcoholic*; Humans; Liver Cirrhosis, Alcoholic; Microbubbles; Mortality; Odds Ratio; Pilot Projects*; Prognosis*; Prospective Studies*; ROC Curve; Survival Rate; Ultrasonics; Ultrasonography*
- From:Gut and Liver 2018;12(5):555-561
- CountryRepublic of Korea
- Language:English
- Abstract: BACKGROUND/AIMS: Acute hepatic dysfunction combined with alcoholic hepatitis (AH) in alcoholic cirrhosis is related to hepatic hypo-perfusion secondary to intrahepatic necroinflammation, neoangiogenesis, and shunt. The hepatic vein arrival time (HVAT) assessed by microbubble contrast-enhanced ultrasonography (CEUS) is closely correlated with the severity of intrahepatic changes. We investigated the usefulness of HVAT to predict short-term mortality of AH in cirrhosis. METHODS: Thirty-nine patients with alcoholic cirrhosis (27 males) and AH were prospectively enrolled. HVAT study was performed within 3 days after admission using ultrasonic contrast (SonoVue®). The primary outcome was 12-week mortality. RESULTS: Twelve-week mortality developed in nine patients. HVAT was significantly different between the mortality and survival groups (9.3±2.0 seconds vs 12.6±3.5 seconds, p=0.002). The odds ratio of a shortened HVAT for 12-week mortality was 1.481 (95% confidence interval, 1.050–2.090; p=0.025). The area under the receiver operating characteristic curve of HVAT for 12-week mortality was 0.787 (p=0.010). The combination of MDF and HVAT ≥11.0 seconds resulted in an 87.5% survival rate even if the MDF score ≥32; however, HVAT < 11.0 seconds was related with mortality despite a MDF score < 32. CONCLUSIONS: HVAT using microbubble CEUS could be a useful additional index to predict short-term mortality in patients with AH and cirrhosis.
